How Can A Grade 3 Nipple Inversion Be Fixed?

Q: Dr. Eppley, I have severe Grade 3 nipple inversion since birth and had a procedure earlier this year with high hopes. It was a release and then attached to a plastic device onto which the nipple was sewn. It did not work and I am extremely disappointed. What are my options at this point?

A: Inverted nipples present in differing severities which have been classified by grades and reflect the degree the nipple is inverted and ho scarred in it is. (milk duct fibrosis) Fundamentally, grade 1 nipple inversions may only occasionally retract and are easily pulled ouot if they do. (no soft tissue deficiency) Grade 2 nipple inversions can be pulled out but retract quickly when released. (very little soft tissue deficiency but with some scar) Grade 3 nipple inversions are very hard to pull and may not even be able to done. There is considerable retraction and scarring and a true soft tissue deficiency exists underneath. While the technique of release and sustained retraction by suturing to an external plastic device is the standard treatment, it is not one I have ever liked and there is risk of nipple necrosis with such sustained retraction. I find that release of the nipple and the placement of an interpositional dermal-fat graft to be a more effective solution.  The key is that scar tissue and the natural shortage of nipple length will pull the nipple right back into hole from whence it came. This is an issue of a tissue defect, not just a release. Constant traction on the nipple by an external device allows the filling of the defect with scar tissue which is highly prone to scar retraction and recurrent nipple inversion as it  heals. A revascularized dermal-fat graft provides a better resistance to scar contracture.

Dr. Barry Eppley

Indianapolis, Indiana